Stage : Mild Dementia
At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:
- Difficulty remembering things about one’s personal history
- Difficulty recognizing faces and people
In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.
When Should Dementia Patients Stop Driving
American Academy of Neurology Offers Guidelines for Taking Away the Car Keys
April 13, 2010 — If a family member with Alzheimer’s disease or other dementia is racking up traffic tickets, getting in repeated fender benders, or exhibiting road rage, it may be time to think about taking away the car keys.
About 4 million Americans have some type of dementia and nearly all will eventually have to give up driving, says Donald J. Iverson, MD, of the Humboldt Neurological Medical Group, Inc., in Eureka, Calif.
Itâs one of the most wrenching decisions a family has to make, forcing the patient to face a loss of autonomy, Iverson tells WebMD. And there’s no hard rule or simple test to tell when a person is poised to become a danger, he says.
In an effort to offer some guidance to patients and their families, Iverson and other experts convened by the American Academy of Neurology recently combed through 6,000 studies and articles to arrive at new guidelines on dementia and driving.
The recommendations were released here at the AAN’s annual meeting and simultaneously published online by the journal Neurology.
How To Stop A Person With Dementia From Driving
Car keys are a symbol of independence for American adults, which usually makes taking them away a daunting task for family caregivers. As our loved ones age, we must be hypervigilant about looking for signs that their mental and physical abilities are changing. This is an extremely delicate subject for most seniors, but under no circumstances should you allow someone to drive if there is any sign of impairment.
Many AgingCare members post in the Caregiver Forum asking for advice on how to stop a person with dementia from driving. Ultimately, preventing a loved one from getting behind the wheel may require taking away their car keys, revoking their drivers license and/or automobile insurance, and possibly even disabling or removing their car.
The extent to which you must go to keep a senior from driving depends entirely on their stubbornness, lucidity and desire to get behind the wheel. Which, again, may be deceiving as these things fluctuate. The extent to which you can legally go to keep them safe also varies. For example, you cannot legally sell a loved ones car unless you have a valid power of attorney for finances that permits you to handle such affairs.
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Transitioning To Living Without Driving
To help you plan ahead for the time when you must stop driving, consider the following strategies:
- Consider alternative forms of transportation. These can be public transit, taxis, services provided by community organizations, and transportation organized by family members and friends.
- Use these alternative forms of transportation while it is still safe for you to drive. This will help you get used to new routines that you will transition to after you hang up the car keys for good. As well, this may help you accept the difficult decision to stop driving when it eventually comes.
- Look into companies that offer home delivery services. These can be pharmacy or grocery home delivery services.
The Skills Required For Driving
Quick reactions: when two cars are bearing down on one another at 60mph, the gap closes at 120mph or 54 metres every second. In two seconds youve closed the length of a football pitch. Its important to be able to react to danger to avoid accidents.
Memory: we have to remember where we are going and what we are doing. We need to remember where we left our car and also the road rules.
Patience and calmness: theres a lot of questionable driving out there, and when someones faculties start to fail, it can cause and extra frustration for them.
Concentration: we have to switch between multiple different tasks while driving, maintaining our attention on what we are doing, anticipating what is going to happen and reading the road ahead.
Spatial awareness: with fast-moving objects all around us we need to be able to maintain the correct speed and distance from other vehicles and the correct road position within the lane.
Problem-solving: sometimes the road throws up unexpected challenges such as a detour, road works or a pedestrian crossing. We need to be able to respond to that appropriately.
Strength: driving requires some physical strength to turn the wheel, get into and out of the car, push the brake pedal and resist against the g-forces of cornering. Dementia doesnt affect this, but dementia tends to affect older people who could have diminished strength.
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Stage : Moderately Severe Dementia
When the patient begins to forget the names of their children, spouse, or primary caregivers, they are most likely entering stage 6 of dementia and will need full time care. In the sixth stage, patients are generally unaware of their surroundings, cannot recall recent events, and have skewed memories of their personal past. Caregivers and loved ones should watch for:
- Delusional behavior
Why Driving With Alzheimers / Dementia Is Dangerous
Someone with Alzheimers or a related dementia can probably continue driving in the early stages of the disease. Over time, however, driving becomes dangerous for absolutely everyone with the disease, and they usually need to stop within three years of their diagnosis. It is hard for someone to admit they shouldnt be behind the wheel. Losing the ability to drive represents a loss of independence and control. It might feel unfair. Yet while respecting dignity and independence is important, nothing trumps safety.
Driving is a complex task. Think of the multitasking required to do these all at once: Recognize traffic signs and signals. Pay attention to other cars. React to other cars. Maintain correct distances on every side. Adapt to changing road or weather conditions. Handle the vehicle, which weighs about two tons and features countless moving parts.
Dementia most famously impacts memory, but focus is also a casualty, and focus is probably the most important part of driving. Someone whose mind cant react quickly, whose reaction time is slower, should not be driving.
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Maintaining Your Driving Ability
The good news is that, while your symptoms are mild, you can take steps to help you drive safely and independently for as long as possible:
- Settle into a consistent routine. Stick to the same route when you drive from place to place. Figure out when you most need to drive, and follow that plan. For example, do you drive to medical appointments, to shop, to meet with friends? Are there times when someone else can drive?
- Drive with someone that can assess your driving abilities on an ongoing basis. They can notice if there are any changes in your driving abilities and can spot risky behaviours that you may not be aware of.
- Use technology to support your capacity to drive. If you’re driving by yourself, use assistive technologies such as a GPS to help you.
- Above all, living well with dementia has been shown to slow the progression of dementia. Challenging your brain, following a good diet and staying physically and socially active will all help you stay in the early stage of dementia for as long as possible.
A Helpful Test You Can Do
If you suspect a person may be showing signs of dementia, give them this simple test on common traffic signs.
Ask What does the sign mean? and What action should the driver take?
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Safety Checklist For Older Drivers
Whatever their age, few drivers could say theyâve never experienced a tricky moment on the roads. Itâs easy to have your confidence knocked, fall into bad habits, or simply forget the things you were taught while learning. There are also health conditions that could affect you while driving, such as visual impairments, arthritis, and muscle weakness. Medication can impact your concentration and ability to drive, too. Discuss this with your doctor, who will be able to advise you.
For older drivers, itâs worth asking a few questions to see if further support is needed:
- Do you feel confident on the roads?
- When was the last time you had a near miss?
- Have you asked if other people feel safe in your car? How do they respond?
- Are you happy to drive and park during busy times of the day? Or do you avoid driving at certain times?
- Are you comfortable with all manoeuvres, including reversing under pressure?
- Have you recently had any comments from other road users?
- Do you know speed limits and common road signs?
If your answers to these questions have made you question your driving ability, donât panic. Some uncertainty means you might benefit from a refresher course, spending a few hours with a driving instructor to brush up on your skills. You canât fail or pass refresher courses are simply meant to provide additional support.
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Appealing The Ministrys Suspension Decision
In Ontario, when a persons license is suspended they receive a letter from the Ministry of Transportation. There are several options of what to do next. One option is to appeal the decision. The letter the Ministry sends will detail this process. The Ministrys website can also be a helpful resource. It includes information about places where a functional driving assessment can be completed. This test is different from a regular drivers test, and it comes a cost, which can vary by location. Before a functional driving test can be performed the individual being tested needs a temporary drivers license. Once a license is medically suspended, the testing organization can request a one day temporary drivers license for the assessment. The Ministry of Transport will need a medical report to verify that the assessment is appropriate. Your doctor needs to file a medical report before the temporary drivers license can requested. This appeals process can be frustrating, especially when appeals are not successful..
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Arrange For An Independent Driving Evaluation
The safest option for assessing a personâs driving skills is to arrange for an independent driving evaluation. Prior to the evaluation, inform the examiners that the person being evaluated has dementia. Evaluations are sometimes available through driver rehabilitation programs or State Departments of Motor Vehicles .
Although laws vary from state to state, some states require physicians to notify the DMV of any patient diagnosed with dementia. The person with dementia may then be required to report to the DMV for a behind-the-wheel driver re-examination. In some states, individuals diagnosed with moderate or severe dementia may have their licenses automatically revoked. To find out about driving and dementia laws, you can call the Department of Motor Vehicles for the state in which the individual resides.
Because symptoms of dementia are likely to worsen over time, individuals who pass a driving evaluation should continue to be re-evaluated every six months. Individuals who do not pass must discontinue driving immediately.
Can You Legally Drive With Alzheimers Or Dementia
This question immediately comes to the minds of family members, but the questions raised are broader than simply, does my state have a law against driving with dementia / Alzheimers?. As relevant are the following questions:
-Do I need to report someone with dementia to the department of motor vehicles ? If so, how soon?-Will our doctor report the individual to our state DMV?-Do I need to notify my car insurance that a driver in my house has dementia?-Will our insurance provider refuse to cover us or raise our rates?
Laws and rules about driving with a diagnosis of Alzheimers vary by state and are often unclear. For example, in California doctors are required to notify the Department of Motor Vehicles if a person has been diagnosed with dementia, and the DMV then issues a request for driver reexamination,. This is a driving test that can result in driving restrictions during certain times of day, or even the full loss of driving privileges. How quickly the reporting and re-examination happen is very vague, as is enforcement. Another example is Texas, where there are no laws about reporting a diagnosis to driving authorities, but anyone can report a potentially unsafe driver to the state DMV. Accordingly, a doctor, a neighbor or even a family member may choose to do so. Then the driver will have to pass a doctors evaluation to stay behind the wheel.
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What Does The Law Say About Driving And Dementia
UK law on driving and dementia is clear. A driver who is diagnosed with dementia must tell their licensing agency straightaway. If they dont, they can be fined up to £1,000.
The doctor, or other healthcare professional should make these rules clear to the person and anyone else, when they diagnose the persons dementia.
Drivers with dementia must also tell their car insurance provider straightaway. If they do not, their policy may not be valid. It is illegal to drive without at least third-party cover.
If a person with dementia wants to keep driving, they must tell DVLA/DVA. The agency will ask about the persons medical information and decide if they are safe to drive. Or DVLA/DVA may ask the person to have a driving assessment. You can find out more about this in the section How to keep driving after a dementia diagnosis.
Some people diagnosed with dementia decide for themselves that they want to stop driving and send their licence back to DVLA/DVA. This is called voluntary surrender.
Thinking of giving up driving?
Read our advice on giving up driving or supporting someone who is no longer driving.
What Happens Once The Ministry Of Transportation Receives Notice From My Physicianclick For Answer
The Ministry of Transportation will review the report from your doctor. They will send you a letter in five to eight weeks indicating one of the following possibilities:
- Your medical report is approved and you can continue driving or
- More medical information is required to make a decision. You will be told in your letter what medical information is needed and the date it is expected or
- You will need to pass a three-part driver’s test administered by Drive Test or
- You will be required to complete a formal driving evaluation at a Ministry Approved Driver Assessment Centre or
- Your license has been suspended. This decision can be reconsidered with up-to-date medical information from your family doctor or specialist confirming your condition has improved.
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More Useful Links And Resources
Conversations about dementia and driving. Alzheimer Society of Canada. In this information sheet, learn how dementia can affect a person’s driving abilities and get strategies to help people living with dementia, caregivers and healthcare providers have conversations about driving cessation.
The Driving and Dementia Toolkit. The Champlain Dementia Network and the Regional Geriatric Program of Eastern Ontario, last updated March 2015. As a person living with dementia or a caregiver, you can download this fillable PDF to assess driving abilities and risks.
Dementia and Driving. Alzheimer’s Association. This webpage from this U.S.-based dementia organization highlights realistic scenarios to help families start the conversation about driving. In English only.
Driving and Dementia. brainXchange, 2015. This webinar focuses on how dementia affects the ability to drive and on the evaluation process to assess fitness-to-drive. This webinar is brought by brainXchange in partnership with the Alzheimer Society of Canada and the Canadian Consortium of Neurodegeneration in Aging . In English only.
Driving and Dementia. Alzheimer Society of B.C., 2020. In this 25-minute video, learn how dementia may affect someone living with dementia’s driving abilities and strategies to ease the transition for driving cessation. In English only.
Introducing The Idea Of Not Driving
Its not uncommon for people to have to stop driving most people have to at some point but it should be acknowledged that its hard to do. The alternatives mentioned above can reduce the feelings of anxiety a person will have over not being able to drive anymore. While most drivers who develop dementia will have fundamentally clean driving records, this doesnt mean that they continue to be safe drivers.
There are financial benefits to selling a car if the person has ready access to public transport or can walk places. There will be no maintenance, fuel and other costs associated with the vehicle. Its possible in some places to rent a parking space to commuters using services such as Parkhound or Kerb which could bring in some money.
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Measures To Stop The Alzheimers Patient From Driving
Families struggle with the decision to limit or stop the family member from driving and the sense of dependence may prevent people with dementia from giving up the car keys. Unfortunately, no examination or single indicator exists to determine when a person with dementia poses a danger to himself or others. Families must determine when a person’s attention span, distance perception or ability to process information makes it difficult for him or her to respond safely in driving situations.